This invention relates to a surgical needle holder and particularly to a needle holder to be used in delicate surgery. The surgical needle holder of this invention is particularly useful in ocular surgery.
Ocular surgery is more delicate than most of the general surgical operations because of the relatively small size of the parts of an eye and those associated with an eye. The instruments used in ocular surgery usually must have correspondingly delicate or fine operating ends or tips. Also, the ocular surgeon is required to handle and manipulate these instruments in relatively small and sometimes minute increments and degrees. The configuration of the surgical instruments can significantly influence the surgeon's ability to execute these delicate manipulations comfortably, confidently, or even successfully.
An example of frequently performed ocular surgery is one to correct strabismus, an imbalance between the muscular control of one eye relative to the other eye. The muscular control of an eye is done by extraocular muscles, or eye muscles of which there are six for each eye. Each muscle has one end attached to the schlera, the firm outer coat that defines the shape of the eye. The other end of the eye muscle is attached to an annular ring located behind and at the apex of the orbit of the eye. The annular ring is attached to the sphenoid bone and is therefore stationary.
The effective length of one or more of these eye muscles may need surgical alteration to correct a strabismus condition. This is accomplished by cutting the eye muscle from the schlera and re-attaching the severed end of the muscle to the schlera at a different location. During this operation carefully performed, delicate suturing is required.
In this suturing procedure, a needle is held or clamped by a needle holder that in turn is held in a surgeon's hand. The surgeon must manipulate the needle holder to push the suturing needle in one direction into the affected area, then he must work the needle laterally, and thereafter push the needle in another, generally opposite, direction out of the affected area. Also, for many reasons, the penetration points of the needle, both to enter and to leave the affected area, and the lateral traverse of the needle between these penetration points, should be accurately controllable by the surgeon.
In the prior art, there are needle holders that clamp a needle between jaws to hold the needle during a suturing operation. A particular problem with the prior art needle holders is that they are awkward to manipulate for the complete suturing operation. Particular problems associated with prior art needle holders are that they require awkward twisting of the surgeon's wrist and/or arm during a suturing operation and the tip of the needle holder is not oriented to the handle to give the surgeon proper visual as well as physical control of the suturing operation.
The typical prior art needle holder has an elongated handle, to be held in the surgeon's hand, with a needle holding tip that is in line with the axis of the body of the needle holder. This typical conventional needle holder may be held in various ways when starting a suture stitch and all of these ways are awkward, requiring severe bending of the surgeon's wrist and/or arm. Also, this conventional needle holder must be held very differently, requiring changes in the surgeon's grip on the needle holder, each time the direction of the needle is to be changed during the suturing process.
Pursuant to the present invention, there is a way that a needle holder should best be held for control of a suturing operation, for comfort to the surgeon, for steadiness of the surgeon's hand, and for accuracy in the exact points of penetration and of the path of traverse of the needle to complete a suture stitch. The needle holder of this invention can be so held.
An important feature of this needle holder is that the orientation of the needle holding tip relative to the body of the holder allows a manipulating motion of the surgeon's hand to be more natural and comfortable than is possible with needle holders of the prior art. In particular, this needle holder can be held, manipulated and controlled with a few of the smaller, more dextrous muscles of the fingers and hand rather than requiring use of a large number of mucles, including wrist, arm and even shoulder muscles that make delicate control complex and difficult. More particularly, in the present invention, the needle holding tip of the instrument consists of a pair of straight, uniformly fine jaws that are oriented at an obtuse angle relative to the axis of the body of the instrument, and the body has a cylindrical gripping section permitting ready rotation, allowing the needle holder to be held and manipulated in a manner similar to that in which a pencil is held and manipulated. This is particulary important in ocular surgery during which the surgeon frequently needs to simultaneously rotate the needle while pushing it through the tissue. The combination of the cylindrical gripping section on the body with the particular angle between the tip and the axis of the body allows these motions with only a few of the surgeon's hand muscles being involved.
It is particularly important to note that the jaws which form the tip are straight and that the juncture of the jaws to the body of the needle holder is relatively sharp and clearly defined. In the prior art, there are needle holders having a curved tip. Such a configuration makes it difficult for the surgeon to determine the best location on the tip for gripping the needle and produces inconsistency in the angle between the needle and the axis of the handle of the needle holder. Also, as the surgeon proceeds through the suturing operation, it is difficult for him to visualize the precise orientation of the suture needle. In addition, this prior art configuration does not provide a sharp definition beween the delicate, fine tip and the relatively more massive body of the needle holder.
The needle holder of the present invention alleviates or eliminates these problems. The jaws of the tip are straight and uniformly fine, with constant small cross-section. An angle is formed between the tip and the axis of the handle to provide maximum control with use of the fewest number of the surgeon's muscles. Since the tip is straight, its entire length defines a single, optimum angle with the axis of the handle. Therefore, the angle of the needle is not altered by where along the tip it is gripped. Furthermore, by observing the angle of the tip relative to the surface being sutured, the surgeon can determine and know the orientation of the needle.
During the course of an operation, a surgeon may need to use a series of different surgical instruments, such as a needle holder, a forceps, a muscle clamp, a muscle hook and others. A problem with the prior art surgical instruments is that different instruments have different weights and different shapes and sizes of handles. Therefore, as he is performing an operation, the surgeon must adapt to the new feel of each instrument as it is handed to him because it will feel strange compared to the instrument the surgeon just used. This lack of consistency in the heft and feel of the surgical instruments can contribute to delay, affect the concentration and perhaps confidence of the surgeon, affect the steadiness with which the surgeon operates, and otherwise interrupt the smooth pace of the operation.
A feature of the present invention is that it provides for a family of ocular surgical instruments wherein the instruments may be different for different surgical purposes, but the weights of the instruments and the size and shape of the handle portions are essentially identical to one another. Thus, when the surgeon moves from one step to another step in the operation, necessitating changes in surgical instruments, the change from one instrument to another does not present an entirely different feeling to the hand of the surgeon but, by contrast, the weight and feel of all of the instruments are consistent to the surgeon.
Another problem with the prior art surgical instruments is that the configuration of the handle is irregular. This irregularity frequently dictates that the instrument can be held in only one or two ways and in only one or two orientations. A feature of the present invention is that the portion of the handle that is held within the fingers of the surgeon is substantially cylindrical, thereby enabling the instrument to be rotated and manipulated infinitesimal amounts as the surgeon may need to do in the course of an operation. The cylindrical shape of the handle greatly reduces the awkwardness of holding and manipulating the surgical instrument during the operaton and keeps the feel of the instrument constant to the surgeon. More particularly, the shape and size of the handle are similar to, and feel like, a mechanical pencil or other writing instrument, causing manipulation of the surgical instrument to resemble that of such a writing instrument. In a family of surgical instruments wherein all have this common cylindrical shaped handle, all the instruments are more accurately controllable and they all feel consistent and familiar to the surgeon.
An object of this invention is to provide a surgical needle holder that can be controlled by relatively few of the small muscles of a surgeon's hand to push, and sometimes simultaneously push and rotate, a needle through flesh being sutured. A related object is to provide such a surgical needle holder wherein the surgeon can observe the orientation of the tip of the needle holder to determine precisely the orientation of the suture needle and can respond to such observation with necessary and desired accurate minute manipulations of the surgical needle holder.
Another object of the invention is to provide a surgical needle holder that is particularly adapted to the requirements of very delicate ocular surgery and that has a tip consisting of a pair of fine jaws that are straight and joined at a distinctly defined obtuse angle to a more massive handle.
A further object of the invention is to provide a surgical needle holder that has a handle with a cylindrical gripping section adapted to be held between the thumb and fingers of a surgeon's hand wherein the handle is long enough to have an end section resting against the hypothenar space of the hand, the other end of the needle holder having a tip for clamping a suture needle, such that the needle holder feels similar to and can be manipulated like a mechanical pencil.
Still another object of the invention is to provide a surgical needle holder which is one of a family of surgical instruments all of which have in common a handle section of cylindrical shape, the lengths and diameters of the handle sections being similar and the overall weights of the instruments being similar, thereby presenting a consistent and familiar heft and feel to the surgeon as he is handed various ones of the instruments in sequence during the course of a surgical operation.
Other objects and advantages will be apparent from the description and claims of the invention.